Most women glide through pregnancy without any trouble bigger than morning sickness, but solid prenatal care is important because symptomless health issues can occasionally arise that can be managed with detection and treatment. One of these issues is gestational diabetes mellitus (GDM). This occurs when a pregnancy hormone interferes with the body's ability to use insulin, the hormone that turns blood sugar into energy resulting in high blood sugar levels. Each year, up to 4 percent of women develop the serious illness, with a small number of them experiencing extreme hunger, thirst and fatigue. Amanda Flatt was one of them. "My thoughts about being pregnant were that I could pretty much eat anything I wanted and that no one would say or do anything because I was pregnant," recalls the Murfreesboro mom of three. She experienced GDM three times. "I had never heard of gestational diabetes, Flatt says. "I was shocked and worried about how to handle it. I was also concerned about the severe craving I was having and not being able to eat what I wanted, " she recalls.
HOW GDM HAPPENS
"GDM occurs when a hormone produced by the placenta called 'human placental lactogen' causes the cell membrane to become resistant to insulin," says Kelly G. Williams, M.D., an OB/GYN at Murfreesboro Medical Clinic and an affiliate with Saint Thomas Rutherford Hospital. "The hormone is produced by the placenta at approximately 24 – 25 weeks. In order to identify the disease, we administer the glucose test in the middle of the second trimester of pregnancy (26 – 28 weeks)," he adds. Sarah Osmundson, M.D., assistant professor of Obstetrics and Gynecology at Vanderbilt University Medical Center, says a GDM diagnosis means the expectant mother develops abnormally high blood sugar levels either from fasting or in response to food. "Some women are diagnosed with GDM earlier in pregnancy because they have risk factors that make them prone to it (obesity, advanced age, strong family history, etc.)," she says. At 25 weeks of pregnancy, Flatt went to the emergency room. "I felt like something was wrong, and I didn't feel right," she says. "It was late in the evening when they checked my sugar; it was in the 400s (I hadn't eaten all day). I spent three weeks in the hospital trying to get it under control and find a balance with insulin and diet. Because of my history, they checked me early with my other two pregnancies and I was positive for both." she adds. Williams says pregnant women shouldn't blame themselves if they get GDM. "There is little if nothing that can be done to prevent it," she says. "It's related to a placental hormone. You cannot cause gestational diabetes. Too many people think the reason they get it is because they did something wrong and that's not accurate," he adds.
It's important to keep GDM under control through a combination of a healthy diet, oral medication or insulin shots. The severity of your diagnosis determines which route your doctor will want you to take. "The best thing that can be done to help is to tightly control blood sugars with diet, exercise and medication if needed," says Osmundson. "I had to be put on pretty high doses of insulin for my first and third pregnancies," recalls Flatt. "But with my second pregnancy, I was able to eat healthily and exercise to keep the levels down on my own." If you're lucky enough to simply modify your diet, know that it's tricky in the beginning to understand how to count the carbohydrates (sugars) in food, but once you get the hang of it, planning daily meals and snacks gets easier. "I was scared that it would be hard, but it really wasn't," Flatt says. "I worked with amazing dieticians and was able to learn great healthy alternatives. I don't remember craving something I couldn't have; I had to learn a balance with diet and exercising," she adds.
WHAT ABOUT THE BABY?
While GDM places restrictions on Mom's diet, other things affect the baby including a higher birth weight, possible complications during delivery and more. "High blood sugars during pregnancy can make the fetus grow too big (macrosomia)," says Osmundson. Ultrasounds will determine whether Baby can be delivered vaginally or if a C-section will be necessary. This may or may not be related to when the GDM diagnosis comes in pregnancy. "The problem with diagnosing GDM late in pregnancy is that it allows the fetus to be exposed to high glucose levels for a longer period of time," says Williams. Not only does it cause Baby to grow larger, but the increase in glucose also causes the fetus to compensate by increasing insulin production. "This increased insulin production causes problems after delivery," he says. Large babies pose problems in vaginal deliveries. "Large babies of diabetic moms may be too big to fit through the birth canal, says Osmundson. "In rare situations, the baby's shoulder can get stuck leading to birth injury. There's also some concern that babies of moms with GDM may be at a higher risk for type 2 diabetes and obesity during their lifetime," she adds. "Diabetic babies are often larger in the chest and shoulders, which can lead to complications in labor such as failure to dilate or possible shoulder dystocia in delivery where the shoulder becomes impacted behind the pubic bone," Williams says. "I didn't have any complications with my deliveries," says Flatt. "My first was born vaginally, the second and third were born via C-section for fear of their sizes," Flatt adds.
After delivery, moms and doctors are watchful of other things. "These babies may have low blood sugars at birth or problems breaking down bilirubin requiring a prolonged stay in the hospital," says Osmundson. "In utero, the baby was in a 'glucose bath,' so when some newborns produce their own glucose, there's too much insulin production and low blood sugar is developed as the glucose is brought into the cells," adds Williams. "These babies often end up with admission to the NICU for blood sugar regulation." Out of her three babies, only Flatt's third, Miranda, had post-birth complications due to GDM. "She had a lot of insulin in her body because of the crazy amounts of insulin I had to take during my pregnancy. Her sugar kept getting too low. I really wanted to nurse her, but I didn't have enough sugar in my breast milk," Flatt recalls. As a result of Miranda's low sugar level, she was given formula instead of breast milk in order to elevate her blood sugar. "She drastically improved with formula, and we were able to avoid the NICU," Flatt says. "Because of that, I had to supplement her with formula in between nursings so her sugar would stay level." Having GDM doesn't necessarily mean having a large baby is automatic. "All three of my children were born at healthy birth weights," says Flatt. "My oldest, Mackenzie (now 10), was 7 pounds 13 ounces; Carter (now 8) was 8 pounds 10 ounces, but I was on the diet-controlled treatment with him; and Miranda (now 1) was 7 pounds 7 ounces," she adds. "Perfect."
POWER OF BEING POSITIVE
If you receive a GDM diagnosis, the most important thing you can do is to keep your chin up, doctors say. "Developing GDM is difficult and frustrating for the mother since she feels like she has done something wrong to hurt her baby," says Williams. "But this is all a part of nature. With modern medicine, we are fortunate to have access to strategies and medications that can help prevent complications." So don't let GDM ruin your pregnancy. Work closely with your doctor to control your blood sugar and together you can make your pregnancy — and the birth of your precious, healthy baby — the special time it is meant to be.